HomeMy WebLinkAbout97-00653
Department 01 the Treasury. Internal Revenue Sarvlce
Form 668 iVI (cl
(Rev, October 1993)
Notice of Federal Tax Lien
District
For Opl/onal Use by Racordlng Olllce
Serlcl Number
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As provided by sections 6321, 6322, and 6323 of the Internal Revenue
Code, we are giving a notice that taxes (Including Interest and penalties)
have baen assessed against the followlng.named taxpayer, We have made
I demand for payment of this tlablllty, but It remains unpaid, Therefore,
there Is a tlen In favor of the United States on all property and rights to
proparty belonging to this taxpayer for the amount of these taxes, and
additional penalties, Interest, and costs that may accrue.
Name 01 Taxpayer
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IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice 01 lien Is refiled by the date given in column (e), this notice shali,
on the day following such date, operate as a certificate of release as defined
In IRC 6325(a),
Tax Period
Ended
(b)
Kind of Tax
(a)
Date of
Assessment
(d)
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Last Day lor Unpaid Balance
Raflllng of Assessment
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Identifying Number
(e)
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Place of Filing
Total $
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This notice was prepared and signed at
, on this,
the day of ,19_,
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(NOTE: Certlllcale of olllesr authorIzed by law to lake acknowledgmenls Is nol essenllallo the validity 01 Notle. 01 Federal Tax lI.n
RIV, Ru!. 71,466,197\ ,2 c,e, 409)
Part 1 . Kept By Recording OUlce
Form 668 (V) (c) (Rev, 10/93)
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